Page:Tropical Diseases.djvu/384

342 most frequently on the right side, affecting one or more of the femoral glands; less frequently (20 per cent.) it is the axillary glands, and still more rarely (10 per. cent.), and most commonly in children, it is the glands at the angle of the lower jaw that are affected. The buboes are usually single; in about one-eighth of the cases, however, they form simultaneously on both sides of the body. Very rarely are buboes formed in the popliteal or in the epitrochlear elbow glands, or in those at the root of the neck. Occasionally buboes occur simultaneously in different parts of the body.

The buboes vary considerably in size. In some instances they are not so large as a walnut; in others they attain the size of a goose's egg. Pain is often very severe; on the other hand, it is sometimes hardly complained of. Besides the enlargement of the gland, there is in most instances distinct infiltration of the surrounding connective tissue.

In a very small proportion of cases what are usually described as carbuncles, but which are in reality small patches of moist gangrenous skin that may gradually involve a large area, develop on different parts of the integument. These occur either in the early stage or late in the disease. Sometimes they slough and lead to extensive gangrene. In favourable cases, sooner or later, after or without the appearance of the bubo, the constitutional symptoms abate with the setting in of profuse perspiration. The tongue now begins to moisten, the pulse-rate and temperature to fall, and the mild delirium, if it has been present, to abate. The bubo, however, continues to enlarge and to soften. After a few days, if not incised, it bursts and discharges pus and sloughs sometimes very ill-smelling. In rare instances suppuration is delayed for weeks; whilst in some the bubo subsides after a few weeks, or perhaps months, without having broken down. Convalescence, when it occurs, sets in some time between the sixth and tenth day, although it may be delayed for a fortnight or three weeks. Occasionally a pysemic condition, with boils, abscesses, cellulitis, parotitis, or